A kidney transplant gives most patients with kidney failure more years and better years than dialysis does. Getting there requires months of evaluation, and that evaluation happens here.
When to start
Earlier than most people think. Once your eGFR falls below 20, you can be evaluated and listed — before dialysis ever begins.
This is called preemptive transplant, and the outcomes are better than transplanting someone who has already spent years on dialysis. Time on dialysis is itself a risk factor for how the graft does afterward. The single most common reason patients miss this window is that nobody started the conversation early enough.
What the evaluation involves
The workup is thorough because a transplant is major surgery followed by a lifetime of immunosuppression, and both need to be survivable.
Cardiac assessment. Stress testing, and in many cases coronary imaging. Heart disease is the leading cause of death after transplant.
Immunologic testing. Blood typing, HLA tissue typing, and a panel reactive antibody level that tells us how sensitized you are — how many potential donors your immune system would reject. Prior transfusions, pregnancies, and previous transplants all raise it.
Cancer screening. Age-appropriate screening, completed and current. Immunosuppression accelerates malignancy, so an occult cancer must be found before, not after.
Infectious serologies. Hepatitis B and C, HIV, CMV, EBV, and tuberculosis screening. Some of these change which donor organs are safe for you and which prophylaxis you will need.
Dental and psychosocial evaluation. An untreated dental infection becomes dangerous under immunosuppression. A patient without a plan for getting to appointments and affording medications is a patient whose graft will fail.
| Step | What happens |
|---|---|
| Referral | You're referred to a transplant center for work-up |
| Testing | Blood, imaging, heart, and cancer screening confirm you're a candidate |
| Listing | Once cleared, you're listed — or matched with a living donor |
What we do and where the surgery happens
We run the evaluation. All of it — the cardiac workup, the tissue typing and crossmatch, the cancer screening, the serologies, the candidacy assessment. We coordinate your listing with the transplant center and manage everything that arises while you wait.
The operation itself is performed at a partner transplant center.
After the surgery, your care comes back to us. We manage your immunosuppressive regimen, monitor tacrolimus and sirolimus levels, watch for rejection and infection, and treat the blood pressure, bone disease, diabetes, and metabolic complications that follow a transplant for the rest of your life. That is the great majority of transplant care, and it is ours.
Living donors
A living donor kidney lasts longer than a deceased donor kidney and avoids years on a waiting list. Donors can be family, friends, or strangers.
If your willing donor is incompatible with you, paired exchange programs can match you both into a chain so that two transplants proceed instead of none. If you are highly sensitized, desensitization protocols may make transplant possible where it otherwise would not be.
Raising the subject with the people in your life is difficult, and we help patients do it.